The Toronto Adolescent and Youth Cohort Study: Study Design and Early Data Related to Psychosis Spectrum Symptoms, Functioning, and Suicidality

BACKGROUND

Psychosis spectrum symptoms (PSSs) occur in a sizable percentage of youth and are associated with poorer cognitive performance, poorer functioning, and suicidality (i.e., suicidal thoughts and behaviors). PSSs may occur more frequently in youths already experiencing another mental illness, but the antecedents are not well known. The Toronto Adolescent and Youth (TAY) Cohort Study aims to characterize developmental trajectories in youths with mental illness and understand associations with PSSs, functioning, and suicidality.

METHODS

The TAY Cohort Study is a longitudinal cohort study that aims to assess 1500 youths (age 11-24 years) presenting to tertiary care. In this article, we describe the extensive diagnostic and clinical characterization of psychopathology, substance use, functioning, suicidality, and health service utilization in these youths, with follow-up every 6 months over 5 years, including early baseline data.

RESULTS

A total of 417 participants were enrolled between May 4, 2021, and February 2, 2023. Participants met diagnostic criteria for an average of 3.5 psychiatric diagnoses, most frequently anxiety and depressive disorders. Forty-nine percent of participants met a pre-established threshold for PSSs and exhibited higher rates of functional impairment, internalizing and externalizing symptoms, and suicidality than participants without PSSs.

CONCLUSIONS

Initial findings from the TAY Cohort Study demonstrate the feasibility of extensive clinical phenotyping in youths who are seeking help for mental health problems. PSS prevalence is much higher than in community-based studies. Our early data support the critical need to better understand longitudinal trajectories of clinical youth cohorts in relation to psychosis risk, functioning, and suicidality.

Educational stakeholders' attitudes and knowledge about nonsuicidal self-injury among university students: A cross-national study

Nonsuicidal self-injury (NSSI) is a commonly occurring, yet historically poorly understood, mental health concern among post-secondary students. The present study sought to identify the current knowledge needs of university stakeholders to inform training efforts around effective NSSI response and student support on university campuses.

Participants were 1,762 university students, staff, and student-staff (77% female) from seven universities in Canada, the USA, New Zealand, and Australia.

Participants completed an online survey about their attitudes and knowledge of both general mental health and NSSI.

University stakeholders reported significantly greater stigma toward NSSI than mental illness in general. Student-staff reported greater perceived knowledge and comfort, and demonstrated greater knowledge of NSSI, than students and staff.

Findings underscore the need for additional training and resources to reduce stigma and increase knowledge about NSSI on university campuses internationally.

What is important to the decision to disclose nonsuicidal self-injury in formal and social contexts?

OBJECTIVE

Disclosure of nonsuicidal self-injury (NSSI) is associated with a range of both positive (e.g., help-seeking) and negative (e.g., discrimination) outcomes. The aim of this study was to assess the importance of a range of factors concerned with: NSSI experiences, self-efficacy to disclose self-injury, interpersonal factors, and reasons for or expectations of disclosure, to the decision to disclose self-injury to friends, family members, significant others, and health professionals.

METHODS

Three hundred seventy-one participants with lived experience of NSSI completed a survey in which they rated the importance of the aforementioned factors to the decision of whether to disclose NSSI to different people. A mixed-model analysis of variance was conducted to investigate whether the factors differed in importance and if this importance differed across relationship types.

RESULTS

All factors held importance, though to differing degrees, with those related to relationship quality being most important overall. Generally, factors relating to tangible aid were considered more important when considering disclosure to health professionals than to other people. Conversely, interpersonal factors, particularly trust, were more important when disclosing to individuals in social or personal relationships.

CONCLUSION

The findings provide preliminary insight into how different considerations may be prioritized when navigating NSSI disclosure, in a way that may be tailored to different contexts. For clinicians, the findings highlight that clients may expect tangible forms of support and nonjudgment in the event that they disclose their self-injury in this formal setting.

Why Are Individuals Who Have Not Disclosed Self-Injury Comfortable Discussing Their Experiences in Research?

ABSTRACT

Not everyone who shares their lived experience of nonsuicidal self-injury (NSSI) in research has disclosed this previously outside of a research context. Our objective was to identify reasons people who have not previously disclosed their NSSI felt comfortable discussing their self-injury in research contexts. The sample consisted of 70 individuals with lived experience of self-injury who had not previously disclosed this experience outside of research (Mage = 23.04 years, SD = 5.90; 75.70% women). Using content analysis of open-ended responses, we identified three reasons participants felt comfortable discussing their NSSI in research. Most commonly, participants did not anticipate negative consequences discussing their NSSI due to the way the research was conducted (e.g., confidentiality). Second, participants valued NSSI research and wanted to contribute to such work. Third, participants referenced feeling mentally and emotionally prepared to discuss their NSSI. The findings indicate that individuals who have not previously disclosed their NSSI may wish to discuss their experience in research for a variety of reasons. Such findings highlight implications for how we foster safe spaces in research for people with lived experience of NSSI.

The role of depressive symptoms and social support in the association of internet addiction with non-suicidal self-injury among adolescents: a cohort study in China

BACKGROUND

Both internet addiction (IA) and non-suicidal self-injury (NSSI) are major public health concerns among adolescents, however, the association between IA and NSSI was not well understood. We aimed to investigate the association between IA and NSSI within a cohort study, and explore the mediated effect of depressive symptoms and the moderating effect of social support in the association.

METHODS

A total of 1530 adolescents aged 11-14 years who completed both the baseline (T1) and 14-month follow-up (T2) survey of the Chinese Adolescent Health Growth Cohort were included for the current analysis. IA, NSSI, depressive symptoms and social support were measured at T1; depressive symptoms and NSSI were measured again at T2. Structural equation models were employed to estimate the mediated effect of depressive symptoms and the moderating effect of social support in the association between IA and NSSI at T2.

RESULTS

IA was independently associated with an increased risk of NSSI at T2, with the total effect of 0.113 (95%CI 0.055-0.174). Depressive symptoms mediated the association between IA and NSSI at T2, and social support moderated the indirect but not the direct effect of IA on NSSI at T2. Sex differences were found on the mediated effect of depressive symptoms and the moderated mediation effect of social support.

CONCLUSIONS

Interventions that target adolescents' NSSI who also struggle with IA may need to focus on reducing depressive symptoms and elevating social support.

More than an outcome: a person-centered, ecological framework for eating disorder recovery

BACKGROUND

Eating disorder recovery is a complex phenomenon. While historical understandings focused on weight and behaviours, the importance of psychological factors is now widely recognized. It is also generally accepted that recovery is a non-linear process and is impacted by external factors. Recent research suggests a significant impact of systems of oppression, though these have not yet been named in models of recovery. BODY: In this paper, we propose a research-informed, person-centered, and ecological framework of recovery. We suggest that there are two foundational tenets of recovery which apply broadly across experiences: recovery is non-linear and ongoing and there is no one way to do recovery. In the context of these tenets, our framework considers individual changes in recovery as determined by and dependent on external/personal factors and broader systems of privilege. Recovery cannot be determined by looking solely at an individual's level of functioning; one must also consider the broader context of their life in which changes are being made. To conclude, we describe the applicability of the proposed framework and offer practical considerations for incorporating this framework in research, clinical, and advocacy settings.

Passive Suicidal Ideation in Childhood

Background: A growing body of empirical research shows that suicidal behaviors are prevalent in childhood. Yet, few studies have examined risk factors related to suicidal ideation (SI) among children aged 12 and younger. Aims: The current study addresses this gap. Method: A questionnaire was filled out by 1,350 Flemish primary caregivers (94.7% mothers) of 9-year-old children (50.4% boys, M_age = 9.45). Their responses were analyzed using logistic regression and independent samples t tests. Results: The presence of passive SI was reported in 10.5% of the children. A psychiatric, developmental, or behavioral condition (or multiple conditions), a learning disorder, impulsivity, aggression, and experiencing multiple stressful family life events were discovered as potential risk factors of passive SI in childhood. Limitations: The cross-sectional nature of this study meant that causality could not be inferred. In addition, it was based on reports of primary caregivers, rather than on reports from the children themselves. Conclusion: These new empirical findings can be used for the development of prevention programs and be taken into account in risk assessments of SI in clinical practice. Confirmation of our findings in a longitudinal child-reported study is needed.

Further Silencing the Voiceless: The Role of Gatekeepers in Accessing Information About Self-Injury

ABSTRACT

Gatekeepers play a pivotal role in protecting individuals under their care and are central to keeping people safe and away from harm. In the field of nonsuicidal self-injury (NSSI), a range of gatekeepers exist, including those who protect access to vulnerable research participants, those who protect school children, those charged with making decisions about funding priorities, and those in charge of clinical care for people who self-injure. The aim of this commentary is to outline the roles these different gatekeepers have in protecting access to research participants, access to NSSI knowledge, and access to clinical care for individuals who self-injure. We provide examples in which gatekeepers may present barriers and offer solutions for how to work with gatekeepers for mutual benefit.

Understanding Discussions of Sexual Assault in Young Women on a Peer Support Mental Health App: A Content Analysis

Trauma narratives may have been influenced by the Me Too movement, with thousands of individuals disclosing sexual violence stories online. Youth, the largest demographic of online users, may prefer the anonymity of the Internet to discuss experiences of sexual assault. Understanding the ways that young women, especially those experiencing mental health difficulties, discuss their experiences is important as they are at higher risk of revictimization and continued poor mental health. We searched for terms related to acts of sexual assault on a mental health peer-support app, TalkLife, and compared the number of posts during the initial wave of the Me Too movement (October 2017-March 2018) to the same time period in the previous year (October 2016-March 2017). We found a significant increase in posts related to sexual assault of 49.7% between the Pre and Post Me Too time periods (p < .001), controlling for a general increase in posts. A content analysis of 700 randomly selected posts found that a substantial number of young women used TalkLife to discuss their experiences of sexual assault, and these self-disclosures were mostly hopeless or depressing in tone. Additionally, neither the nature nor the number of self-disclosures varied across time points. The negative tone of the self-disclosures in the current study is worrying because the way women talk about their trauma can shape how they understand it, which could lead to negative self-appraisal and continued mental health difficulties. Online spaces have the potential to support young women and facilitate help-seeking, but we must be attentive to how they are used.

Lived experience perspectives on a definition of eating disorder recovery in a sample of predominantly white women: a mixed method study

BACKGROUND

There has recently been a push for recovery-focused research in the eating disorder (ED) field, starting with a consensus definition of recovery. One definition, in particular, proposed by Bardone-Cone et al. [21] has received considerable attention given its transdiagnostic nature and validation studies. However, no studies to date have elicited lived experience views of this definition. The goal of the current study was to examine perspectives on this definition of recovery from individuals with a past or present ED and to determine whether participant agreement with the model differed based on diagnostic history or current symptom severity.

METHODS

Sixty-two individuals (95.2% women; 91.9% White/European) participated in a 1-2 h interview aimed at capturing their perspectives on ED recovery. Transcripts were analyzed using qualitative content analysis and codebook thematic analysis to examine agreement with and thoughts on Bardone-Cone's definition of recovery, respectively. Chi-squared tests of independence and binary logistic regression were computed to determine whether agreement with the definition differed across diagnostic history and self-reported symptoms.

RESULTS

Although some participants indicated acceptance of the definition, the majority expressed concerns related to its categorical nature, proposed criteria, feasibility, language, and applications. There were no differences in acceptance based on diagnostic history or current symptom severity.

CONCLUSION

A single definition of recovery does not seem to fit individuals' lived ED experience. Future research may benefit from distinguishing between recovery as an individually-defined phenomenon and related constructs such as remission (i.e., loss of diagnosis or absence of clinical symptoms). A more comprehensive multi-faceted, and person-centered model of recovery may have merit in clinical settings.

Adding Insult to Injury: The Accumulation of Stigmatizing Language on Individuals With Lived Experience of Self-Injury

ABSTRACT

Language is a powerful form of communication that not only conveys ideas and knowledge but also can assign meaning and value to the world around us. As such, language has the power to shape our attitudes toward individuals, behaviors, and ideas, by labeling them (indirectly or not) as "good" or "bad." In this way, language can be used to propagate stigma and other unhelpful attitudes toward individuals who already experience stigma. One behavior that may be particularly prone to the impact of unhelpful language is nonsuicidal self-injury (NSSI). In this article, we draw on Staniland's NSSI stigma framework to demonstrate how an individual with lived experience of NSSI may be exposed to stigmatizing messaging through 30 different channels, and propose that the accumulation of these messages may be particularly damaging. We conclude by offering practical tips for clinicians and researchers wishing to empathically work with individuals who self-injure.

Peer-Presented Versus Mental Health Service Provider-Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial

BACKGROUND

University students are reporting concerning levels of mental health distress and challenges. University mental health service provider initiatives have been shown to be effective in supporting students' mental health, but these services are often resource-intensive. Consequently, new approaches to service delivery, such as web-based and peer support initiatives, have emerged as cost-effective and efficient approaches to support university students. However, these approaches have not been sufficiently evaluated for effectiveness or acceptability in university student populations.

OBJECTIVE

Thus, the overarching goal of this study was to evaluate a mental health service provider-presented versus peer-presented web-based mental health resilience-building video outreach program against a wait-list comparison group.

METHODS

Participants were 217 undergraduate students (mean age 20.44, SD 1.98 years; 171/217, 78.8% women) who were randomly assigned to one of the intervention groups (mental health service provider-presented: 69/217, 31.8%; peer-presented: 73/217, 33.6%) or the wait-list comparison group (75/217, 34.6%). Participants in the intervention groups were asked to watch 3 brief skill-building videos addressing strategies for building mental health resilience, whereas the comparison group was wait-listed. The mental health service provider-presented and peer-presented video series were identical in content, with presenters using a script to ensure consistency across delivery methods, but the videos differed in that they were either presented by mental health service providers or university students (peers). All participants were asked to complete web-based self-report measures of stress, coping self-efficacy, social support, social connectedness, mindfulness, and quality of life at baseline (time 1), 6 weeks later (time 2, after the intervention), and 1-month follow-up (time 3).

RESULTS

Results from a series of 2-way ANOVAs found no significant differences in outcomes among any of the 3 groups. Surprisingly, a main effect of time revealed that all students improved on several well-being outcomes. In addition, results for program satisfaction revealed that both the mental health service provider-presented and peer-presented programs were rated very highly and at comparable levels.

CONCLUSIONS

Thus, findings suggest that a web-based mental health resilience-building video outreach program may be acceptable for university students regardless of it being mental health service provider-presented or peer-presented. Furthermore, the overall increases in well-being across groups, which coincided with the onset and early weeks of the COVID-19 pandemic, suggest an unexpected pattern of response among university students to the early period of the pandemic. Limitations and barriers as well as research implications are discussed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05454592; https://clinicaltrials.gov/ct2/show/NCT05454592.

Support Seeking in the Context of Self-Injury Recovery: Perspectives From Individuals With Lived Experience

ABSTRACT

A sample of 229 university students responded to open-ended questions for the present study, which aimed to gain a deeper understanding of lived experiences of support seeking in the context of self-injury recovery. Inductive thematic analysis of the responses indicated themes from two domains: the benefits of support seeking and the barriers to support seeking. The first domain highlighted benefits from both professional sources (such as receiving diagnosis and referrals to therapy, learning emotion regulation strategies, and developing an improved understanding of self) and informal sources (such as receiving tangible aid, having a support system, and having a compassionate space). The second domain indicated that barriers could be both intrapersonal (such as desire to continue nonsuicidal self-injury, embarrassment and shame, establishing agency without others' support, and minimizing self-injury) and interpersonal (such as fear of being stigmatized, concern for others, and unhelpful prior experiences) in nature. Implications for future research, outreach efforts, and clinical practice are discussed.

Characterizing the content, messaging, and tone of trichotillomania on YouTube: A content analysis

BACKGROUND

Trichotillomania is associated with secrecy and reluctance to seek help due to shame and lack of knowledge. Social media can connect people with similar lived experience. However, there is no literature regarding online communities related to trichotillomania. This study is a content analysis of depictions of trichotillomania on YouTube to identify the potential role of social media in this disorder.

METHODS

We used a cross-sectional observational study to examine the 100 most-viewed YouTube videos for trichotillomania content until June 2018. Up to 96 variables were abstracted from each video including demographics, characteristics of the videos, and depictions of trichotillomania.

RESULTS

View counts ranged from 9,186 to 15,597,149. Uploaders had a mean age of 20.1 years, were mostly female (85%) and appearing Caucasian (63%). Nearly half of the videos were self-filmed stories (48%). Most had a neutral message (44%), provided strategies to stop hair-pulling (31%), or focused on stimulating discussion (17%). Approximately half had a factual tone (51%) and many were hopeful (44%). Videos accurately described hair-pulling and associated characteristics.

LIMITATIONS

This study was limited to an analysis of video content. Future research should examine the comments on the videos as well as other social media platforms. It may also be important to assess the socioeconomic status of video uploaders and ensure the broader accessibility of positive messages on trichotillomania.

CONCLUSIONS

People with trichotillomania may find positive messages, information, and helpful recommendations on YouTube. This may represent an under-leveraged venue to improve clinical outcomes for people with trichotillomania.

Leveraging the Strengths of Psychologists With Lived Experience of Psychopathology

Psychopathology is a common element of the human experience, and psychological scientists are not immune. Recent empirical data demonstrate that a significant proportion of clinical, counseling, and school psychology faculty and graduate students have lived experience, both past and present, of psychopathology. This commentary compliments these findings by leveraging the perspectives of the authors and signatories, who have personal lived experience of psychopathology, to improve professional inclusivity in these fields. By "coming out proud," the authors aim to foster discussion, research, and inclusion efforts as they relate to psychopathology experiences in psychological science. To that end, the authors describe considerations related to disclosure of lived experience, identify barriers to inclusion, and provide concrete recommendations for personal and systemic changes to improve recognition and acceptance of psychopathology lived experience among psychologists.

Only Human: Mental-Health Difficulties Among Clinical, Counseling, and School Psychology Faculty and Trainees

How common are mental-health difficulties among applied psychologists? This question is paradoxically neglected, perhaps because disclosure and discussion of these experiences remain taboo within the field. This study documented high rates of mental-health difficulties (both diagnosed and undiagnosed) among faculty, graduate students, and others affiliated with accredited doctoral and internship programs in clinical, counseling, and school psychology. More than 80% of respondents (n = 1,395 of 1,692) reported a lifetime history mental-health difficulties, and nearly half (48%) reported a diagnosed mental disorder. Among those with diagnosed and undiagnosed mental-health difficulties, the most common reported concerns were depression, generalized anxiety disorder, and suicidal thoughts or behaviors. Participants who reported diagnosed mental disorders endorsed, on average, more specific mental-health difficulties and were more likely to report current difficulties than were undiagnosed participants. Graduate students were more likely to endorse both diagnosed and undiagnosed mental-health difficulties than were faculty, and they were more likely to report ongoing difficulties. Overall, rates of mental disorders within clinical, counseling, and school-psychology faculty and trainees were similar to or greater than those observed in the general population. We discuss the implications of these results and suggest specific directions for future research on this heretofore neglected topic.

Correlates of disclosure of non-suicidal self-injury amongst Australian university students

Purpose

Non-suicidal self-injury (NSSI) is associated with psychological disorders and suicidal thoughts and behaviours; disclosure of NSSI can serve as a catalyst for help-seeking and self-advocacy amongst people who have self-injured. This study aims to identify the socio-demographic, NSSI-related, socio-cognitive and socio-emotional correlates of NSSI disclosure. Given elevated rates of NSSI amongst university students, this study aimed to investigate these factors amongst this population.

Design/methodology/approach

Australian university students (n = 573) completed online surveys; 80.2% had previously disclosed self-injury.

Findings

NSSI disclosure was associated with having a mental illness diagnosis, intrapersonal NSSI functions, specifically marking distress and anti-dissociation, having physical scars from NSSI, greater perceived impact of NSSI, less expectation that NSSI would result in communication and greater social support from friends and significant others.

Originality/value

Expanding on previous works in the area, this study incorporated cognitions about NSSI. The ways in which individuals think about the noticeability and impact of their NSSI, and the potential to gain support, are associated with the decision to disclose self-injury. Addressing the way individuals with lived experience consolidate these considerations could facilitate their agency in whether to disclose their NSSI and highlight considerations for health-care professionals working with clients who have lived experience of NSSI.

Self-Injury Is My Drug: The Functions of Describing Nonsuicidal Self-Injury as an Addiction

ABSTRACT

Adolescents and emerging adults who engage in nonsuicidal self-injury (NSSI) often participate in online activity regarding their self-injury. Of particular importance are the potential benefits and risks associated with online NSSI activity, including how individuals describe their NSSI experiences. One way that individuals describe these experiences is by discussing NSSI as an addiction. Accordingly, we used thematic analysis to explore why individuals may use addiction references to describe their NSSI experiences. To do this, we examined 71 posts from a popular NSSI social network. Four themes emerged: difficulty inherent in stopping, authentication, warn others, and communicate the plight of the behavior. Findings highlight a number of avenues for research as well as implications for clinicians working with clients who self-injure perceive NSSI as an addiction. Mental health professionals can leverage their understanding of clients' perceptions of NSSI to better serve this population.

Reconceptualizing Recovery: Integrating Lived Experience Perspectives Into Traditional Eating Disorder Recovery Frameworks

Eating disorder recovery has long been conceptualized as comprising the domains of weight, behaviors, and thoughts. Criteria for these domains are generally absolute (e.g., no specified behaviors in a set time frame) and determined by researchers and/or clinicians. This Open Forum draws on the knowledge of experts with lived experience to situate their perspectives against existing models of eating disorder recovery. Definitions of eating disorder recovery could be improved by deemphasizing a single weight target in recovery and acknowledging the nonlinear nature of thoughts and behaviors. The authors provide examples of ways that clinicians and researchers can integrate these improvements into their practice.

Media guidelines for the responsible reporting and depicting of non-suicidal self-injury

Media coverage of non-suicidal self-injury (NSSI) ranges from providing helpful education to displaying graphic images. We offer the first research-informed, consensus-based guidelines for the responsible reporting and depicting of NSSI in the media, while also advising on ideas for dissemination and collaboration between media professionals and healthcare experts.

A Randomized Controlled Trial Evaluating a Pain Training for Respite Workers Supporting Children With Disabilities Part Two: Training Evaluations and the Impact of Training on Knowledge Application

Within a parallel-group randomized control trial, pain training's impact on Respite Workers' (RW) care approaches and training evaluations was explored. RW (n = 158) from 14 organizations received pain or control training following randomization. Researchers were blind until randomization; allocations were not shared explicitly with organizations/participants. Participants completed a strategy use questionnaire immediately before and an evaluation immediately after training completion. Four-to-6 weeks later, participants completed the strategy use questionnaire and semistructured focus groups. No differences in pain approaches were noted in strategy use questionnaires. Per focus groups, both groups acquired a "knowing" about pain and applied pain-related care approaches in similarly. Pain training participants identified need for "growing and strengthening" pain knowledge. Training endorsements were favorable. RW pain training has value and may impact practice.

A Randomized Controlled Trial Evaluating a Pain Assessment and Management Program for Respite Workers Supporting Children With Disabilities Part One: Pain-Related Knowledge and Perceptions

This parallel group randomized controlled trial tested effectiveness of the Let's Talk About Pain training on respite workers' (RW) pain-related knowledge and feasibility-confidence-skill ratings using between-group and within-group analyses. Fourteen children's respite organizations were randomized to pain or control training. Participants (nintervention = 66; ncontrol = 92) underwent a 3-3.5 hour training and completed measures at pre-, post-, and 4-6 week follow-up. Intention-to-treat (nintervention = 65; ncontrol = 92) and per-protocol (nintervention = 26-38; ncontrol = 40-57) analyses were conducted. Pain training participants demonstrated significantly higher pain knowledge and feasibility-confidence-skill ratings post-follow-up versus control group and significant increases in knowledge from pre-post. Significant gains were maintained from post-follow-up. Results represent a promising step towards enhancing pain-related care for children with IDD.

Understanding Self-Injury: A Person-Centered Approach

Nonsuicidal self-injury is a common and serious concern because of its association with multiple psychiatric difficulties and illnesses as well as its robust association with suicidal thinking and behavior. Yet many individuals who self-injure find it difficult to talk about their experiences, and many service providers find addressing self-injury challenging. Accordingly, and commensurate with a recent and growing trend in the field, this Open Forum presents a person-centered framework for discussion of self-injury. This conceptualization emphasizes the distinct experiences and needs of individuals, which can help cultivate stronger rapport and greater engagement when implemented during interactions with people who self-injure. In turn, this framework is conducive to improving service provision while contributing to greater confidence and job satisfaction for providers.

The Language of Self-Injury: A Data-Informed Commentary

ABSTRACT

Nonsuicidal self-injury (NSSI) is a behavior that can be perplexing to many people. Usually engaged as a means of regulating intense or unwanted emotions, it seems to counter the human instinct to avoid pain and harm to the self. The language people use to talk about NSSI, and individuals who engage in the behavior, can contribute to the significant stigma that is associated with NSSI. In this data-driven commentary, we report on the language clinicians and researchers typically use when talking about NSSI, and the language they consider appropriate to use. We observed some disparity in the language people use and what they deemed appropriate. Notably, researchers and clinicians report underusing terms that people with lived experience find most appropriate (someone with a history of self-injury; someone with lived experience of self-injury). We call on all researchers and clinicians to be mindful of the language they use to discuss NSSI and adopt person-centered and respectful language at all times.

Perceived vs. Actual Emotion Reactivity and Regulation in Individuals With and Without a History of NSSI

Non-suicidal self-injury (NSSI) has consistently been associated with self-reported difficulties in emotion reactivity and the regulation of negative emotions; however, less is known about the accuracy of these self-reports or the reactivity and regulation of positive emotions. The present study sought to investigate differences between women with and without a history of NSSI on: (a) self-reported general tendencies of negative and positive emotion reactivity, (b) self-reported general tendencies of negative and positive emotion regulation, and (c) emotion regulation reported in response to a positive and negative mood induction. The sample consisted of 36 women with a recent history of NSSI within the last 2 years (Mage = 20.06; SD = 1.51) and a comparison group with no history of NSSI (n = 34; Mage = 20.15; SD = 1.54). Participants completed self-report measures of negative and positive emotion reactivity and regulation. In a separate session, participants underwent both a negative and positive mood induction using a counterbalanced design and reported their experienced emotions. Results from two-way MANOVAs and ANOVAs revealed those with a history of NSSI reported significantly greater difficulties in negative emotion reactivity and regulation than the no-NSSI comparison group; however, no group differences emerged in self-reported reactivity or regulation of positive emotions. In contrast, repeated measures ANOVAs on data from the mood induction task found no group differences in reactivity or regulation for either negative or positive emotions. These findings highlight the possibility that although individuals with a history of NSSI evaluate their ability to manage negative emotions as significantly worse than individuals with no history of self-injury, this may not reflect their actual emotion regulatory processes.

The importance of feasible outcome evaluations: Developing stakeholder‐informed outcomes in a randomized controlled trial for children’s respite workers receiving pain training

Objective

Pain is common for children with intellectual and developmental disabilities. It is critical that caregivers have adequate pain assessment and management knowledge. The Let’s Talk About Pain program has shown promise to provide pain‐related knowledge and skills to respite workers; however, more systematic evaluation of the program is needed. This study aims to support Let’s Talk About Pain’s RCT development by using stakeholder input to help determine a feasible approach for collecting behaviorally based outcomes. A secondary aim is to discuss relevant considerations and implications for others in the disability field conducting similar work.

Methods/Design

Four employees in children’s respite organizations completed telephone interviews lasting approximately fifteen minutes and a questionnaire about feasible data collection approaches.

Results

The use of questionnaire and focus group methodology was determined to be the most feasible method to evaluate participants’ pain‐related approaches in practice.

Conclusions

Special consideration should be made when making methodological‐related choices during study development to help ensure study feasibility. The iterative approach described in this paper may also be helpful in clinical settings when designing program evaluations to enhance feasibility and suitability; it is particularly important for multifaceted organizations supporting individuals with complex needs including those with intellectual and developmental disabilities.

Needs of Youth Posting About Nonsuicidal Self-Injury: A Time-Trend Analysis

PURPOSE

Many youth who engage in nonsuicidal self-injury (NSSI) go online for information, resources, and support. Although research has noted the potential benefits and risks of online NSSI activity, little is known about the NSSI-related needs that youth express on social media, and, importantly, when these posts occur. This study elucidates the nature of these NSSI-related needs and how they may vary temporally, by time of day or day of week.

METHODS

A total of 3,500 posts made by 2,799 users of an international mental health-focused social network app were analyzed for the presence of NSSI-related needs. Posts were coded using a rubric that was developed using existing knowledge about youth's online NSSI activity. Furthermore, prominently expressed needs were tested for associations with specific times of the day and days of the week.

RESULTS

Users' frequently posted about suicidal ideation and behaviors, and difficult emotions; documented NSSI urges and interpersonal difficulties; and expressed feeling misunderstood and isolated. Furthermore, specific needs occurred more frequently during different times of the day (e.g., users were more likely to express suicidal ideation and behaviors just before midnight).

CONCLUSIONS

These findings have important implications for mental health professionals and policy makers. Youth who post about NSSI could benefit from the provision of tailored, evidence-based resources during times of need. Furthermore, clinicians may need to assess youth's online activity to inform intervention strategies and meet their NSSI-related needs.

Psychologists with lived experience of non-suicidal self-injury: Priorities, obstacles, and recommendations for inclusion

The science and practice of psychology are improved by fostering an inclusive environment for professionals with lived experience of mental illness, sometimes referred to as "prosumers". Non-suicidal self-injury (NSSI) is an increasingly prevalent behavior that occurs across the spectra of mental disorders, and that is associated with greater stigma than many other mental health concerns. Further, individuals with lived experience of NSSI may face unique challenges, for instance, due to the visible nature of NSSI scarring. In this commentary, we describe the negative consequences associated with stigmatizing and excluding people with lived experience of NSSI from the profession of psychology, both for impacted individuals and for the field as a whole. We then provide recommendations to individuals with and without lived experience of NSSI to facilitate inclusion of people with lived experience of NSSI in clinical, research, teaching, and leadership domains. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining Adherence to Suicide Reporting Guidelines in Initial Reports on High-Profile Celebrity Suicides

Background: Research has found varying adherence by media professionals to recommendations for reporting on suicide. Aims: We compared adherence to recommendations for what to do and what not to do when reporting on suicide in initial reports of high-profile celebrity suicides in major media outlets. Method: A total of 100 articles published in news outlets during 2004-2018 and reporting on celebrity suicides were examined for adherence to reporting guidelines using content analysis. Results: Articles frequently adhered to guidelines for what not to do when reporting on suicide (83%), but rarely adhered to guidelines for what to do (26%). Limitations: This study was a single cross-sectional analysis and may not generalize to different outlets, guidelines, or countries. Conclusion: While news articles frequently do not include harmful information, they also do not include potentially protective content.

Impact of the COVID-19 pandemic on students at elevated risk of self-injury: The importance of virtual and online resources

Non-suicidal self-injury (NSSI), which involves deliberate damage to body tissue without suicidal intent, has long been a concern for schools and school staff. Secondary schools are an ideal setting in which to identify, and appropriately refer, students who self-injure as well as implement evidence-based prevention and early intervention programs. However, in the context of the global COVID-19 pandemic, schools have been closed and students sent home to learn online. This may result in the exacerbation of existing anxieties and pose several new stressors that cumulatively may increase risk of NSSI. In this article, we draw on recent research and our collective experience working with schools, as well as digital mental health, to outline some of these potential stressors and offer resources for school staff to help students who are engaging in or at risk of NSSI.

#recovery: Understanding recovery from the lens of recovery-focused blogs posted by individuals with lived experience

OBJECTIVE

Definitions of eating disorder (ED) recovery have primarily focused on symptom management (i.e., weight regain, reduced/absent ED behaviors, and normalized ED thoughts). Notwithstanding the importance of these approaches, there are arguably additional considerations in ED recovery. In order to get a more comprehensive understanding of recovery, it is necessary to turn to individuals with lived experience. Here, we examine how individuals with lived experience of an ED conceptualize and define recovery in narrative, recovery-focused blogs and consider how this understanding may contribute to definitions of recovery in the field.

METHOD

Inductive thematic analysis was used to examine 168 blogs posted by at least 120 unique authors (95% women; 36% reporting anorexia nervosa diagnosis) to 10 moderated, ED websites.

RESULTS

Results from the thematic analysis yielded seven themes: recovery as (1) existing in contrast to the ED, (2) existing in a broader context, (3) subjective, (4) a choice, (5) a complex, nonlinear process, (6) transformative, and (7) overcoming.

DISCUSSION

The present findings are consistent with previous qualitative research, suggesting that recovery is multifaceted and encompasses more than just symptom management. Notably, bloggers highlighted that recovery may not be equally attainable for all individuals, citing numerous social justice issues in the conceptualization of recovery. This multifaceted and intersectional view of recovery is consistent with consumer models of recovery. We argue that a dimensional model of recovery may be a good starting framework for researchers and clinicians to develop a more comprehensive definition of recovery.

Association of Internet Addiction With Nonsuicidal Self-injury Among Adolescents in China

IMPORTANCE

Both nonsuicidal self-injury (NSSI), defined as the direct, deliberate damage of one's body tissue without suicidal intent, and internet addiction among adolescents are public health concerns. However, the possible association of NSSI with internet addiction is not well understood.

OBJECTIVE

To examine the occurrence of internet addiction with NSSI and any sex differences among Chinese adolescents.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter, cross-sectional, survey study was conducted from February 18 to October 15, 2015, among adolescents aged 11 to 20 years from 343 classes in 45 public high schools across 5 provinces of China. Data analysis was performed from August 1, 2018, to March 1, 2019.

EXPOSURES

Possible internet addiction and internet addiction.

MAIN OUTCOMES AND MEASURES

Less-frequent (1-4 times) NSSI and more-frequent (≥5 times) NSSI were surveyed using the Chinese version of the Functional Assessment of Self-Mutilation.

RESULTS

A total of 15 623 students (8043 male [51.5%] and 7580 female [48.5%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) participated. Of these, 4670 participants (29.9%) met the criteria for possible internet addiction and 509 participants (3.3%) met the criteria for internet addiction. A total of 2667 students (17.1%) engaged in less-frequent NSSI, while 1798 students (11.5%) engaged in more-frequent NSSI in the 12 months preceding the survey. Both possible internet addiction and internet addiction were associated with less-frequent or more-frequent NSSI. The adjusted odds ratios were 1.29 (95% CI, 1.17-1.42) for possible internet addiction and 1.41 (95% CI, 1.11-1.80) for internet addiction for less-frequent NSSI; for more-frequent NSSI, the adjusted odds ratios were 1.75 (95% CI, 1.56-1.96) for possible internet addiction and 2.66 (95% CI, 2.10-3.38) for internet addiction. These associations were similarly observed among age groups of 11 to 14, 15 to 17, and 18 to 20 years. No sex disparities were found in the associations of internet addiction with NSSI, except among adolescents aged 11 to 14 years, where the odds ratios for possible internet addiction with less-frequent NSSI were higher in male adolescents (1.53; 95% CI, 1.25-1.88) than female adolescents (1.13; 95% CI, 0.90-1.47).

CONCLUSION AND RELEVANCE

Internet addiction appears to be associated with NSSI, and the findings of this study suggest that the association was similar between male adolescents and female adolescents. These data suggest that evaluation of the risk of NSSI for adolescents in association with internet addiction may help health care professionals in developing preventive interventions for NSSI.

Rethinking self-injury recovery: a commentary and conceptual reframing

A growing body of research has focused on understanding what may contribute to cessation of self-injury. Although these efforts are of value, cessation represents just one component of self-injury recovery. Exclusive or primary focus on cessation may foster unrealistic expectations for those with lived experience of non-suicidal self-injury (NSSI). Accordingly, this commentary discusses the importance of expanding the concept of NSSI recovery beyond cessation in both research and clinical domains. We conclude by presenting a person-centred and non-stigmatising conceptual reframing of recovery.

Advocacy for improved response to self-injury in schools: A call to action for school psychologists

Over the past several years, nonsuicidal self-injury (NSSI) has emerged as a widespread concern in school settings worldwide. However, despite significant strides in NSSI research, there remains a substantial knowledge gap with respect to what school staff know. Unfortunately, this can contribute to stigma and ineffective responding when working with students who self-injure. In light of its high rates and the risks with which NSSI associates, including death by suicide, this is worrisome. Accordingly, there is a pressing need for advocacy in schools to ensure that NSSI is prioritized and for proper knowledge and training be offered to school staff. The current article serves as a call to action for school psychologists as leaders and advocates in meeting these needs. We begin by articulating the central issues pertinent to low NSSI literacy and high NSSI stigma in schools, followed by a series of research-informed recommendations for timely and effective advocacy. By virtue of undertaking these initiatives, school staff will be better able to respond to the needs of youth who self-injure and advocate for them. This, in turn, can foster an enhanced school climate and greater student well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Putting the "Self" in Self-Injury Research: Inclusion of People With Lived Experience in the Research Process

Worldwide, nonsuicidal self-injury has emerged as a paramount concern given its associations with psychiatric difficulties and suicide risk. Despite many gains in the understanding of self-injury, there remain numerous unanswered questions in the field, including how to enhance both treatment and service provision. With this in mind, this Open Forum represents a call to action, advocating and providing strategies for inclusion of people with lived experience in self-injury research. An inclusive approach to self-injury research can yield greater understanding about how to best serve the needs of those who self-injure and others who are affected by self-injury.

When language is maladaptive: recommendations for discussing self-injury

Purpose

The purpose of this paper is to call on researchers and clinicians to carefully consider the terminology used when discussing non-suicidal self-injury (NSSI), and specifically the use of the term “maladaptive” coping.

Design/methodology/approach

Drawing on literature regarding stigma, language and self-injury to support the argument that the term maladaptive is inappropriate to describe self-injury.

Findings

Use of the term maladaptive conflates short-term effectiveness with long-term outcomes and ignores context in which the behaviour occurs.

Social implications

Use of the term maladaptive to describe self-injury can invalidate the person with a history of NSSI, impacting stigma and potentially help-seeking. An alternate framing focussed on specific coping strategies is offered.

Originality/value

Language is a powerful medium of communication that has significant influence in how society shapes ideas around mental health. In proposing a change in the way the authors’ talk about self-injury there is potential to significantly improve the wellbeing of people with lived experience of self-injury.

Conducting research on nonsuicidal self-injury in schools: Ethical considerations and recommendations

Research on nonsuicidal self-injury (NSSI) has grown significantly over the last 15 years, with much of this work focused on factors that initiate and maintain NSSI among school-aged youth. Although this work is important, it does raise several ethical concerns. In this article we outline key ethical issues underlying NSSI research in schools and offer recommendations for conducting ethically sound and productive research in this area. Ethical concerns addressed include: 1) recruitment of minors to research; 2) disclosure and confidentiality; 3) the risk of iatrogenic effects; 4) duty of care; 5) engaging schools in research; and 6) safety of the researchers. In each area, we offer recommendations to assist researchers, ethics committees, and schools in working together to conduct ethical NSSI research, further our understanding of NSSI, and address and respond to these behaviors in schools.

Mobile Apps for Self-Injury: A Content Analysis

A growing body of research points to the salience of the Internet and mobile material among individuals who self-injure. However, to date, no research has investigated the mobile apps related to nonsuicidal self-injury (NSSI). Such information would clarify which apps may be useful for those who self-injure while highlighting whether app-related content warrants improvement. The current study examined the content and usability of NSSI apps available on the two largest app-related platforms (Google Play and iTunes). Using content analysis, apps were examined regarding their content (e.g., presence of NSSI myths and types of coping strategies) as well as usability (e.g., app performance). Results indicate that NSSI apps have varied content, with few developed by, or affiliated with, a trusted source (e.g., university). NSSI apps tend to not propagate NSSI myths that vary with respect to the quality of coping strategies offered. They also tend to be rated favorably in terms of their usability. Overall, the present findings add to the NSSI literature and highlight several implications and avenues for future work, which are discussed.

The impact of YouTube peer feedback on attitudes toward recovery from non-suicidal self-injury: An experimental pilot study

Background

Non-suicidal self-injury (NSSI) is a serious public health concern facing adolescents and young adults worldwide. Despite growing concern that accessing NSSI content on the internet may negatively influence perceptions toward NSSI recovery, no studies have examined actual impacts.

Objectives

This experimental pilot study assessed the impact of exposure to hopeless versus hopeful peer messages on perceptions toward NSSI recovery. It was hypothesized that exposure to hopeless messages would lead to more negative perceptions about NSSI recovery whereas the opposite would occur for hopeful messages.

Methods

We developed fictional peer comments embedded in a screenshot of an NSSI-themed YouTube video and randomly assigned participants to either hopeless or hopeful recovery-oriented comments. Participants’ attitudes toward NSSI recovery, recovery-oriented subjective norms, and recovery self-efficacy were measured pre- and post-exposure using an online questionnaire.

Results

Sixty-one participants with a self-reported NSSI history (mean age 20.89 years) completed the online survey. There was a statistically significant effect for attitudes toward recovery. Within the hopeful comment condition, there was an increase in positive attitudes toward recovery and in recovery-oriented subjective norms. Participants exposed to hopeless peer messages did not report an increase in hopeless attitudes toward NSSI recovery.

Conclusions

Our pilot study indicated that exposure to hopeful online messages improved positive attitudes toward recovery and recovery-oriented subjective norms, while exposure to hopeless messages did not increase hopeless attitudes. Future research on the impacts of online peer comments on one’s attitude toward NSSI recovery and support-seeking behavior could further inform practices and policies.

Food and Mood: Diet Quality is Inversely Associated with Depressive Symptoms in Female University Students

Researchers have found support for an inverse association between diet quality and depressive symptoms in middle-aged adults. This association has not been well examined among university students, a population at risk of developing both depression and unhealthy lifestyle habits. We sought to examine the cross-sectional association between depressive symptoms and diet quality in female university students. One hundred and forty-one females (19.1 ± 1.5 years, 22.3 ± 3.4 kg/m²) were recruited from a Canadian university in 2012 and 2013. Dietary intake data were collected using 3-day food records and analysed using the Canadian Healthy Eating Index. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results of a linear regression demonstrated an inverse association between depressive symptoms and diet quality score (β = -0.016, 95% CI = -0.029 to -0.003, P = 0.017). Elevated depressive symptoms were associated with consumption of diets of poor nutritional quality in our female university student sample. Thus, healthy eating may correspond with lower levels of depression in young adult females.